Sinusitis in Children

What are sinuses?

The sinuses are cavities, or air-filled spaces, near the nasal passage. Like the nasal passage, the sinuses are lined with mucous membranes. There are four different types of sinuses:

Ethmoid sinus. Located inside the face, around the area of the bridge of the nose. This sinus is present at birth, and continues to grow.

Maxillary sinus. Located inside the face, around the area of the cheeks. This sinus is also present at birth, and continues to grow.

Frontal sinus. Located inside the face, in the area of the forehead. This sinus does not develop until around 7 years of age.

Sphenoid sinus. Located deep in the face, behind the nose. This sinus does not develop until adolescence.

What is sinusitis?

Sinusitis is an infection of the sinuses near the nose. These infections usually occur after a cold or after an allergic inflammation. There are four types of sinusitis:

Acute. Symptoms of this type of infection last less than 12 weeks and get better with the appropriate treatment.

Chronic. These symptoms last longer than 12 weeks.

Recurrent acute. Four or more episodes of acute sinusitis in a year.

What causes sinusitis?

Sometimes, a sinus infection happens after an upper respiratory infection (URI) or common cold. The URI causes inflammation of the nasal passages that can block the opening of the paranasal sinuses, and result in a sinus infection. Allergies can also lead to sinusitis because of the swelling of the nasal tissue and increased production of mucus. Other possible conditions that can lead to sinusitis include:

Abnormalities in the structure of the nose

Infections from a tooth

Nose injury

Foreign objects stuck in the nose

Cleft palate

Gastroesophageal reflux disease (GERD)

When secretions are blocked, bacteria may begin to grow. This leads to a sinus infection, or sinusitis.

What are the symptoms of sinusitis?

The symptoms of sinusitis depend greatly on the age of the child. The following are the most common symptoms of sinusitis:

Nasal congestion

Thick, colored nasal drainage

Postnasal drainage (down the back of the throat)

Headache

Cough

Pain or soreness over sinuses

Fever

Loss of smell

The symptoms of sinusitis may look like other conditions or medical problems. Always see your child's health care provider for a diagnosis.

How is sinusitis diagnosed?

Generally, your child's health care provider can diagnose sinusitis based on your child's symptoms and physical exam. In some cases other tests may be done to confirm the diagnosis. These may include:

Sinus X-rays. Diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film. (X-rays are not typically used, but may help assist in the diagnosis.)

Computed tomography (also called CT or CAT scan). An imaging method that uses X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body.

Cultures from the sinuses. Lab tests that involve the growing of bacteria or other microorganisms to aid in diagnosis.

What is the treatment for sinusitis?

Your child’s health care provider will figure out the best treatment based on:

How old your child is

His or her overall health and medical history

How sick he or she is

How well your child can handle specific medications, procedures, or therapies

How long the condition is expected to last

Your opinion or preference

Treatment of sinusitis may include the following:

Acute sinusitis may get better on its own. When it doesn’t, your child's health care provider may prescribe:

Antibiotics. If your child's sinuses are infected with bacteria, antibiotics are given to kill the bacteria. If after 3 to 5 days, your child's symptoms haven't improved, the health care provider may try a different antibiotic.

Allergy medicines. For sinusitis caused by allergies, antihistamines and other allergy medicines can reduce swelling.

Note: Do not use over-the-counter decongestant nasal sprays without checking with your child's health care provider. They may make symptoms worse.

Recurrent acute sinusitis is also treated with antibiotic and allergy medicines. Your child's health care provider may refer you to an ear, nose and throat (ENT) specialistfor testing and treatment.

Treatment for chronic sinusitis may include:

Referral to specialist. Your provider may recommend you see an ear, nose, and throat (ENT) specialist.

Antibiotics. Your may need to take antibiotics for a longer time. If bacteria aren't the cause, antibiotics won't help.

Inhaled corticosteroid medicine. Nasal sprays or drops with steroids are often prescribed.

Other medicines. Nasal sprays with antihistamines and decongestants, saltwater (saline) sprays or drops, or mucolytics or expectorants (to loosen and clear mucus) may be prescribed.

Allergy shots (immunotherapy). If your child has nasal allergies, shots may help reduce his or her reaction to allergens such as pollen, dust mites, or mold.

Surgery. Surgery for chronic sinusitis is an option, although it is not done very often in children.

Care may also include the following:

Fluids. A glass of water or juice every hour or two is a good rule. Fluids help thin mucus, allowing it to drain more easily. Fluids also help prevent dehydration.